The prenatal detection of congenital anomalies of heart walls is very rare. We present a unique series of 8 cases with prenatal echocardiographic monitoring, treatment and postnatal follow-up, providing new insight into this “mysterious” heart problem
Aneta Krasoń, Joanna Płużańska, Maciej Łukaszewski, Jadwiga Moll and Maria Respondek-Liberska
Prenatal diagnosis of total anomolous pulmonary venous connection (intracardiac) was diagnosed in fetus with dextrocardia and complex heart defect, which allowed fetal echocardiography monitoring, planning the time and place for delivery as well as early cardiac surgery. The differences between prenatal and postnatal evaluations were underlined. Despite life treathening condition neonate was asymptomatic without any heart murmur for the first 3 days after delivery.
Joanna Płużańska, Jacek Więcek, Michał Krekora, Jolanta Kiełbasicz-Binikowska, Tomasz Talar, Maciej Słodki and Maria Respondek-Liberska
We present the case of aneurysm of the muscular intraventricular septum with accompanying cardiomegaly and abnormal venous flow patterns requiring emergency cesarean section and specialized neonatal treatment. At the age of 8 months our patient has no clinical symptoms with a 6 mm scar in intraventricular muscular septum..
Joanna Płużańska, Kinga Jaguszewska, Jolanta Binikowska, Adam Oleś, Maciej Łukaszewski and Maria Respondek-Liberska
We present an extraordinary case of congenital enlargement of the right atrium diagnosed at 31 weeks of gestation. This case emphasizes the fact that timing of the detection of this particular cardiac malformation is of capital importance to tract the optimal treatment strategy in order to monitor further progression (in this case accompanying thrombosis) and prevent complications.
Katarzyna Piątek, Katarzyna Zych-Krekora, Joanna Płużańska, Ewa Gulczyńska and Maria Respondek-Liberska
Complains about prenatal diagnoses usually touch late diagnosis, missed diagnosis or uncomplete diagnosis. Prenatal diagnose provides usually important information for parents, obstetrician and neonatologist. Successful perinatal care is based on a good cooperation of the perinatal team. This time we present a peculiar situation when improper reading of prenatal diagnosis had caused a lot of troubles for the patient, parents and hospital staff.
Łukasz Sokołowski, Maria Respondek-Liberska, Michał Krekora, Joanna Płużańska and Maciej Słodki
Introduction: The aim of this study was to evaluate the following parameters of fetuses and neonates with omphalocele: the prevalence of coexisting congenital heart defects (CHD), abnormalities in heart function and the impact of coexisting CHD on fetal and neonatal survival. Material and methods: The study group consisted of 69 fetuses with omphalocele diagnosed and monitored at the Department of Prenatal Cardiology in our Institute in the years 2007-2017. The retrospective analisis of patients' data was performed. For statistical analysis we used Chi-square test, t-Student test and U Mann-Whitney test.. Results: In the studied group omphalocele was an isolated defect in 31.9% of the cases (22/69), in 68.1% (47/69) coexisting defects were present, in 49.3% (34/69) the coexisting defect was CHD. The most common CHD coexisting with omphalocele were ventricular septal defect (VSD), double outlet right ventricle (DORV) and atrio-ventricular septal defect (AVSD). Abnormalities of heart function were present in 43.5% (30/69) of fetuses with omphalocele: 23.5% (8/34) with normal heart anatomy and in 62.9% (22/35) with CHD. Statistically significant differences between the group with normal heart anatomy and the group with CHD regarded: Cardiovascular Profile Score (CVPS) (median 10 points vs median 9 points, U Mann-Whitney test p=0.034), neonatal birth weight(mean 3253 g vs median 2700 g, U Mann-Whitney test p=0.003), Apgar score (median 8 vs median 7, U Mann-Whitney test p=0.038) and survival rate until discharge from hospital (85% vs 52.9%, Chi-square test p=0.034). The comparison of data from 2007-2017 with data obtained from similar analysis performed in our center in 1999-2006, revealed significant improvement in the early detection of omphalocele (median 14.5 weeks of gestation vs mean 25.4 weeks of gestation), gestational age of delivery (mean 38 weeks of gestation vs mean 34 weeks of gestation) and survival rate until discharge both in neonates with normal heart anatomy and coexisting CHD (85% and 52.9% vs 70% and 23% respectively) . Conclusions: 1. The presence of coexisting CHD is an important prognostic factor in fetuses and neonates with omphalocele, so early fetal echocardiography should be performed in every case of omphalocele. 2. During the last decade (2007-2017), in contrast to years 1999-2006, we observed significant improvement in early and complete prenatal diagnosis of omphalocele. 3. We observed improvement in strategy of obstetrical management resulting in delivering neonates in a more advanced gestational age both in the group with normal heart anatomy and the group with coexisting CHD.
Maria Respondek-Liberska, Joanna Płużańska, Katarzyna Zych-Krekora, Ewa Czichos, Maciej Słodki and Jadwiga Moll
From 2012-2014 we selected fetuses who had an isolated congenital heart defect and restriction of the foramen ovale defined as its diameter of 4 mm or less, shunt across foramen ovale, V max > 70 cm/sec along with a typical harsh sound during fetal ausculation during echocardiography and reversal flow in pulmonary veins, no extracardiac anomalies, singleton pregnancies and delivery > 37 weeks of gestation. It was retrospective analysis of 16 cases: There were 10 non-survivors and 6 survivors The only significant difference between survivors and non-survivors pertained to the fraction of newborns operated on up to 11th day, which was significantly higher among the survivors (5/6 vs. 2/8, p=0.031).
1) In the event of prenatal restriction of the foramen ovale early surgery by day 10 had a statistically better outcome in terms of survival compared to cases that underwent surgery at a later period at our Institute.
2) Prenatal restriction of the foramen ovale was more often related to male gender and in 75% of cases in our series had complicated follow-up: neonatal death or prolonged hospital stay.3) Information from prenatal echocardiography regarding restriction of the foramen ovale should be taken into consideration as valuable information suggesting priority for early cardiac surgery.
Iwona Strzelecka, Joanna Płużańska, Jerzy Węgrzynowski, Tomasz Moszura, Maciej Słodki and Maria Respondek-Liberska
Most heart defects form between 4 and 6 weeks after fertilization. The detection rate is still growing. Despite significant progress in prenatal diagnosis some cases still go undetected. We present two cases of similar defects: prenatally detected and undetected, both presenting with a normal four chamber view in mid-pregnancy. We compared the follow-up of both neonates along with sustained health and economic consequences. The dynamics of the development of heart defects during prenatal life suggests the legitimacy to perform additional, late echocardiography exams (35-38 weeks of gestation)
Joanna Płużańska, Paweł Dryżek, Hanna Moczulska, Maciej Słodki, Michał Krekora, Ewa Gulczyńska, Tomasz Moszura, Jadwiga Moll and Maria Respondek-Liberska
Pulmonary valve stenosis is a congenital heart defect that is possible to detect and diagnose during prenatal life. We present a retrospective analysis of ten cases with isolated critical pulmonary valve stenosis (IPVS) to establish echocardiographic criteria which could predict the possibility for postnatal balloon valvuloplasty performed shortly after delivery.